Nebraska Department of Health and Human Services
On January 31, The Department of Health and Human Services (DHHS) Division of Medicaid and Long-Term Care (MLTC) issued the final versions of the Applied Behavior Analysis (ABA) Medicaid Service Definitions (MSDs). These service definitions are effective February 7, 2025.
DHHS received over 300 comments from ABA providers and members of the community. DHHS sincerely thanks all providers who rendered their input on the draft versions of these MSDs during the open provider review and feedback period. All comments were carefully reviewed and used to inform changes and clarifications in the final service definitions.
DHHS is committed to ensuring quality of care for children with Autism Spectrum Disorder (ASD) and other developmental disorders. The Nebraska ABA MSD guidelines were developed in consultation with Doctoral Board Certified Behavior Analysts (BCBA-Ds), psychologists, psychiatrists, and physicians, who considered industry best practices, Council of Autism Service Providers (CASP) guidelines, national trends for ABA services, and the developmental appropriateness of services for the individuals being served.
Main areas of MSD clarifications:
- Hours of service
- Provider requirements
- Schools as a place of service
- Parent and caregiver involvement
- Individualized Treatment, Recovery, and Rehabilitation Plan review and update frequency versus Prior authorization frequency
- Recovery
- Supervision requirements
- Crisis
- Scope of practice
The federal Office of Inspector General (OIG) is auditing Medicaid claims for ABA services. A recent study in Indiana showed the state made at least $56 million in improper fee for service Medicaid payments for ABA.
Federal auditors are looking at other states’ ABA guidance and utilization to find possible misuse, fraud, and inefficiencies. In Nebraska, ABA services have increased over 1,200%, emphasizing the need for vigilance when it comes to ensuring proper service payments.
To learn more about ABA therapy and MSDs, visit https://dhhs.ne.gov/Pages/Applied-Behavior-Analysis.aspx.